One-stage Soave pull-through for Hirschsprung's disease: A comparison of the transanal and open approaches☆
Section snippets
Materials and methods
The patient population consisted of all children less than 3 years of age who underwent a Soave pull-through over a 7-year period. Surgical approach was determined by surgeon preference. Patients were excluded from the study if they had total colon disease or had a previous colostomy, leaving 37 children for analysis. The patients were divided retrospectively into 3 groups: open Soave (OS), transanal Soave with routine laparoscopic visualization (LVS), and transanal Soave with selective
Results
There were 13 patients in the open Soave (OS) group, 9 in the group undergoing a transanal Soave with routine laparoscopic visualization (LVS), and 15 in the transanal Soave with selective laparoscopy or minilaparotomy (TAS) group. Of the 15 children in the latter group, 11 underwent a transanal pull-through alone. Two underwent laparoscopy with biopsy before beginning the perineal dissection, because female gender and a strong family history raised suspicion of long segment disease
Discussion
These data suggest that the 1-stage Soave procedure using a transanal technique is associated with a similar rate of postoperative complications as the same procedure done using an open approach. However, the transanal approach has the advantages of a significantly shorter hospital stay, less need for narcotic analgesics, and lower cost when compared with the open approach.
We have not compared the transanal approach to the various laparoscopic procedures that are becoming increasingly popular.
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Cited by (110)
Nationwide Outcomes of Immediate Versus Staged Surgery for Newborns with Rectosigmoid Hirschsprung Disease
2023, Journal of Pediatric SurgeryMajor stoma related morbidity in young children following stoma formation and closure: A retrospective cohort study
2022, Journal of Pediatric SurgeryComparison of clinical outcomes after total transanal and laparoscopic assisted endorectal pull-through in patients with rectosigmoid Hirschsprung disease
2022, Journal of Pediatric SurgeryCitation Excerpt :However, there are concerns that TERPT causes more anal sphincter damage because the exposure of the anal canal is longer and more forceful when the whole operation is performed through the anus [5–7]. The literature comparing bowel function after total transanal and transabdominal ERPT procedures is inconclusive [4,8-11]. Transabdominal ERPT includes operations assisted with both laparoscopy and laparotomy, but these entities are not necessarily identical with respect to preservation of the anal sphincters.
Risk factors for short-term complications graded by Clavien-Dindo after transanal endorectal pull-through in patients with Hirschsprung disease
2022, Journal of Pediatric SurgeryCitation Excerpt :This increased risk after laparotomy-assisted TERPT can be explained by a few factors: first, a selection bias, introduced by the fact that surgeons will more likely opt for laparotomic-assistance in complex patients. Secondly, some surgeons find the mobilization of the splenic flexure more challenging during laparotomic-assistance, potentially resulting in more traction on the anastomosis, compared to colonic mobilization of the splenic flexure via laparoscopy [29,30]. Thirdly, laparotomic-assistance was used more frequently during implementation of the TERPT, when the surgeons were less familiar with the technique, which could have introduced a bias caused by the learning curve of the technique rather than the laparotomic approach that may have led to a higher complication rate [27].
Laparoscopic-assisted transanal pull-through (LATP) versus complete transanal pull-through (CTP) in the surgical management of Hirschsprung's disease
2016, Journal of Pediatric SurgeryCitation Excerpt :There was a significant difference in surgery duration between groups, with CTP being completed in less time than LATP (2.6 ± 0.6 h vs. 3.9 ± 1.1 h, p = 0.001). The literature search yielded 423 abstracts, from which 17 articles (12 LATP [12–23], 3 CTP [24–26], and 2 comparative [27,28]) were included (Fig. 1). The main reasons for study exclusion were surgical procedures and outcomes that were not of relevance for this review.
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Address reprint requests to Jacob C. Langer, MD, Chief, Pediatric General Surgery, Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1X8.